Inmates over 50 fastest growing prison population

While North Carolina has moved to cut the cost of inmates' medical treatment, state officials say expenses will continue to trend upward.

By Brian FreskosBrian.Freskos@StarNewsOnline.com

Norwood Wright is not the same man who came to prison in 1976 sporting an afro and long sideburns. Wright, who celebrated his 79th birthday in June, has lived as inmate No. 454888 since beginning a 181-year sentence for killing two people. He shed the disco look ages ago. His hairdo dwindled to a close-crop of gray stubble as an old man's step replaced the young man's strut. Wright is among the 16 percent – inmates 50 or older who make up the fastest growing cohort of North Carolina's prison population. Between 1995 and 2011, the number of prisoners over 50 swelled from 1,137 to 5,693, a 400 percent increase, while the overall prison population jumped only 35 percent, according to N.C. Department of Public Safety. The trend presents a significant challenge for policy makers trying to hold down prison costs.While North Carolina has moved to cut the cost of inmates' medical treatment, state officials say expenses will continue to trend upward because of the rapidly expanding group of graying prisoners. The issue raises as much of a fiscal dilemma as a moral one in a state facing successive budget deficits and conservative calls for less government spending.

The problem is in the numbers. The cost of prison health services more than tripled between fiscal years 1997 and 2010, when medical expenses totaled $253 million. In 2011, the tab fell to $239 million, a welcome decline that Keith Acree, a public safety department spokesman, attributed to numerous cost-saving measures. That includes caps on billed charges, the opening of new state medical facilities and a growing reliance on telemedicine, which allows inmates to receive treatment at prisons instead of in outside hospitals.The aging issue is not unique to North Carolina. Rather, it is a trend taking hold around the nation. But tightening budgets have prompted some states to review their policies. "They're beginning to pay attention to it," said Robert Greifinger, an adjunct professor of health and criminal justice at John Jay College in New York. "But it's very difficult because of the politics involved. Politicians do not want to be seen as soft on crime."

The so-called silver tsunami hitting North Carolina is the result of sentencing reforms implemented in 1994. By abolishing parole for crimes committed after that year, the legislature effectively lengthened prison terms for repeat, violent offenders. But freedom can prove elusive even for inmates sentenced under the old laws. Wright said he lost his most recent bid for parole a few weeks ago. The N.C. Parole Commission is not scheduled to reconsider his case until 2015. In the meantime, poor health keeps Wright shuffling between doctors. He underwent open-heart surgery earlier this year. He is diabetic and takes numerous medications. "The state can obtain Medicaid reimbursement when Medicaid-eligible inmates are hospitalized outside prison, or treated at hospitals or medical providers in the community," Acree said in an email. "The cost of all other inmate medical care is borne by the state." Acree added that he could not comment on whether Wright was Medicaid-eligible because of privacy laws. State lawmakers recently overhauled North Carolina's criminal justice system in a bid to rein in ballooning prison costs. While the reforms are estimated to save hundreds of millions of dollars in coming years, the state does not expect them to resolve the price of health care because sentencing requirements still determine who comes to prison and for how long, Acree said.

North Carolina is similar to other states in that it allows for the release of elderly inmates deemed too feeble to pose a risk to public safety. But critics charge that these policies, known as compassionate or medical release laws, are so narrow that few inmates qualify. North Carolina only considers prisoners who are permanently or totally disabled, geriatric or terminally ill. Inmates incarcerated for the most serious violent felonies or those required to register as sex offenders upon release are ineligible. Despite those restrictions, North Carolina let out 61 prisoners on medical release since the law took effect in 2008, the public safety department said. That is more than other states. As of 2009, Oregon, for example, had released no more than two prisoners per year, according to a recent report in the American Journal of Public Health.Freeing inmates for health reasons often times shifts the cost of care onto Medicaid. But Greifinger points out that the taxpayer funded program is less pricey thanks to federal subsidies and the absence of capital and security costs. "While its a cost shift, it's still less expensive, especially for the state," he said. Most inmates who die behind bars do so of natural causes, a trend likely to increase as the prison population ages. In fact, the leading cause of death from 2001 to 2011 was cancer, which killed 293 inmates during that period. Another 234 died from cardiac issues. The system tallied 32 suicides, one homicide, and 11 overdose or accidental deaths between those years. Wright hopes to be paroled before becoming a statistic. In an interview at the New Hanover Correctional Center, where he is serving out a sentence for two murders that took place in Wilmington, he reflected on his life behind bars, and what he might do if ever released. "The only thing I want to do now if I get out of jail is work, get a job, go to church, and come back to the place where I be staying at," he said. "All them clubs, all them different places I used to run – that out of my head now. "I guess because I'm getting older."

Brian Freskos: 343-2327On Twitter: @BrianFreskos

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